As far as illnesses go, breast cancer is a relatively common one: 13 percent of women in the United States will develop breast cancer over their lifetime, according to the National Cancer Institute. That works out to one in eight women, so if you know more than eight women, odds are you probably know someone who has had or will be diagnosed with breast cancer in the future.
And if you’re trying to understand your risk of developing breast cancer or if you or a loved one are facing a diagnosis, that means one thing: You probably have questions for a doctor.
To help you assemble your list, we asked Virginia Kaklamani, MD, leader of the Breast Cancer Program at UT Health San Antonio MD Anderson Cancer Center, for her advice on what to ask. According to Dr. Kaklamani, there are a few important things to keep in mind as you’re crafting your questions, such as your family history, lifestyle risk factors, and available treatment options.
On the treatment front, Dr. Kaklamani says one of the misconceptions she hears most often is that breast cancer treatment always involves chemotherapy and is very toxic. In response, she reminds people how far treatment options—and the tools we have to determine which treatment may work best for each individual person—have come in the past 20 years.
Case in point: Just last year, a landmark study published in The New England Journal of Medicineshowed that, thanks to a genomic test called the Oncotype DX Breast Recurrence Score® test, even more patients with a common type of early-stage breast cancer may be spared chemotherapy than previously thought, including those who are traditionally considered higher-risk due to their cancer spreading to at least one lymph node. That means more treatment plans tailored to each individual patient, and less of a chance of overprescribing chemo to those who may not benefit from it.
Learning something already? With education in mind, we asked Dr. Kaklamani to share her insights on questions you should ask your doctor about breast cancer—whether you’re trying to stay on top of your health, or you’re exploring your breast cancer treatment options.
What role does race play in breast cancer?
There are many factors that contribute to breast cancer risk, including age, family history, alcohol consumption, obesity, and race. White women are most likely to develop breast cancer, Dr. Kaklamani says, though Black women are more likely to die from it (40 percent more likely, according to the Centers for Disease Control and Prevention).
“Studies have shown that Black women have a higher risk of being diagnosed with later stages of disease,” Dr. Kaklamani says. “So instead of coming in with stage one or stage two, they might come in with stage two or three or even stage four breast cancer. It’s been very hard to understand why. Most of the data suggests that it’s related both to the type of breast cancer that they get (because they get more triple negative breast cancer—that’s more aggressive, so we tend to find it later), but also to socioeconomic factors.”
By asking your doctor to discuss the connections between race and breast cancer with you, you’ll be able to more openly advocate for yourself and properly assess your personal risk factors.
What types of tests are available to provide insight about a breast cancer treatment plan?
If you have breast cancer, you should definitely ask your doctor for a thorough rundown on your treatment options, Dr. Kaklamani says, starting with the types of tests available to help craft your individual treatment plan.
Genomic tests—like the Oncotype DX® test—look at the specific genes in a tumor to see whether they are over- or under-active. For people diagnosed with early-stage invasive breast cancer (HR-positive and HER2-negative with or without involvement of the lymph nodes), the Oncotype DX Breast Recurrence Score® result tells patients and their doctors not only how aggressive their cancer is and the risk of it returning, but more importantly, whether chemotherapy might be a beneficial treatment option or if it can be safely omitted, Dr. Kaklamani says.
“The good thing about the [result that you get from the Oncotype® test] is that it’s specific to the woman that we are testing,” she says. “All of these clinical trials that we’ve done have included thousands and thousands of women, [but] none of those women are present in my office when I talk to that specific person about their breast cancer. [Each test result] represents that woman’s breast cancer.”
Personalized is obviously better when it comes to something as delicate as cancer treatment (you wouldn’t take someone else’s prescription medicine, would you?), so asking your doctor about genomic testing can help ensure you’re getting a treatment plan that’s properly tailored to your needs.
Should I be doing a self breast exam?
In 2015, the American Cancer Society stopped recommending that people perform their own breast exams, but that doesn’t mean you’re off the hook for keeping tabs on your breast health, Dr. Kaklamani says.
“The guidelines are very clear that there has to be what they call ‘breast self awareness,'” she says. “This is extremely important to be aware of what your breasts look like, and if you do notice something that has changed, that you see your physician immediately.”
Dr. Kaklmani notes that one study showed that nurses who were taught how to properly perform self breast exams were able to accurately detect their breast cancer—demonstrating that if people are properly trained, self breast exams can be effective. That training should fall on gynecologists and primary care physicians, she says, so ask yours for instructions during your next visit.
If you or a loved one are diagnosed with breast cancer, visit www.chemoyesorno.org to learn more about the Oncotype DX Breast Recurrence Score test.
Dr. Kaklamani is a paid consultant for Exact Sciences Corporation.
Top Photo: Stocksy/Boninstudio
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